Currentsierra health and lifePolicy N/A

11.1 BARIATRIC SURGERY REFERRAL GUIDELINE

Guidance for referring patients to specified surgical weight control centers and the dietary prerequisites/requirements tied to member benefit plans prior to bariatric surgery referral and scheduling.

Policy Summary

Payersierra health and life

Policy11.1 BARIATRIC SURGERY REFERRAL GUIDELINE

Policy CodePolicy N/A

Change TypeInformational

Effective Date

Next Review Date

Key ActionSubmit the referring patient's information to the chosen surgical center using provided contact details; confirm diet prerequisites per benefit plan or refer to Health Education and Wellness Center for medically supervised nutrition counseling.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes were reported for this policy.

2Listed Surgical Centers

2Plan-specific diet requirement options

Bariatric surgery referral guideline — at-a-glance

Applies to referring providers sending patients to the two listed surgical weight control centers (Surgical Weight Control Center and LV Surgery Associates). Verify plan-specific dietary prerequisites before scheduling bariatric surgery or refer patients to the Health Education and Wellness Center for medically supervised nutrition counseling if prerequisites are unmet. Payer: Sierra Health and Life — Policy: Bariatric surgery referral guideline (status: CURRENT).

Scope and intent

Contacts and referral instructions for two surgical weight control centers are provided, and referring providers should submit the referring patient’s information to the office they are referring to. Plan-specific dietary prerequisites apply (see below); if those diet requirements are not met, refer the member to the Health Education and Wellness Center for medically supervised nutrition counseling. Coverage stance: informational.

Referral and pre-surgical requirements

Referral and Pre-surgical Requirements

Referral and pre-surgical procedural requirements for bariatric surgery referrals to listed surgical centers:

ALL of the following

Submit the referring patient's information to the office you would like to refer to (contact details provided).
Patient may need to attend an informational seminar prior to proceeding with surgical guidelines.
Patient must bring insurance card and ID to appointments.
Dietary requirement depends on member benefit plan
- HPN HMO/POS (Tier 1 benefit): requires 6 consecutive months of diet within the past 24 months.6 consecutive months within the past 24 months
- Medicaid/Nevada Check-up: requires 3 consecutive months of diet within the year of surgery.3 consecutive months within the year of surgery
If diet requirement is not met, refer member to Health Education and Wellness Center to schedule medically supervised nutrition counseling appointment: (702) 877-5356.

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What providers must do

Prior Authorization

Referral submission

Submit the referring patient's information to the chosen surgical center using the provided contact details (phone/fax/email). Note the patient may need to attend an informational seminar prior to proceeding with surgical scheduling. Instruct the patient to bring their insurance card and photo ID to appointments.

Documentation Required

Dietary requirement documentation

Document and verify the required consecutive months of diet based on the member's benefit plan. If the diet requirement is not met, refer the member to the Health Education and Wellness Center to schedule a medically supervised nutrition counseling appointment at (702) 877-5356.

HPN HMO/POS (Tier 1 benefit): 6 consecutive months of diet within the past 24 months
Medicaid/Nevada Check-up: 3 consecutive months of diet within the year of surgery
Referral option: Health Education and Wellness Center – (702) 877-5356

Billing Rule

Member inquiries and plan-specific routing

Direct inquiries about out-of-pocket costs for gastric bypass surgeries to Member Services using the plan-specific numbers listed. Follow routing expectations by plan when members ask about cost responsibility.

HPN Member Services: (702) 242-7300
Medicaid/Nevada Check-up Member Services: (702) 242-7317

Surgical center contacts and referral routing

Contacts and referral instructions for two surgical weight control centers are provided. Referring providers should submit the referring patient’s information to the office they are referring to and may need to ensure the patient attends any required informational seminar and brings insurance card and ID to appointments.

Resources and next steps

Available resources: refer members who do not meet diet prerequisites to the Health Education and Wellness Center at (702) 877-5356 for medically supervised nutrition counseling. For inquiries about out-of-pocket member costs related to gastric bypass, route members to Member Services per plan: HPN (702) 242-7300 and Medicaid/Nevada Check-up (702) 242-7317.